Mind-Body Therapies Help Veterans Heal

By Bryan D. Vargo

The toll of both mental and physical trauma on military veterans is staggering. About 1 in 3 veterans have post-traumatic osteoarthritis (PTOA), a unique form of OA that is associated with acute traumatic joint injury, and up to a quarter of Veterans who seek medical treatment after returning from the conflicts in Iraq and Afghanistan suffer from post-traumatic stress disorder (PTSD), according to the U.S. Department of Veteran Affairs (VA). Untreated, PTOA can have serious physical limitations and lead to disability. PTSD can trigger flashbacks, nightmares, depression and hostility, and significantly increase the risk of mental and substance use disorders, and even chronic physical diseases.

The good news is there is a growing trend in mind-body therapies that have little to no risk or side effects that often accompany traditional pharmacological therapies. These mind-body treatments, such as yoga and tai chi, deep breathing, mindfulness, immersive virtual reality, have all been gaining ground in the treatment of both mental and physical trauma among veterans and the general public. This trend is largely in part due to an ever-growing awareness of the opioid epidemic, a strong health care trend focused on mental health and a deeper understanding of the connection between the mind and the body when it comes to healing.

Mind and body issues go hand-in-hand — one ultimately affects the other, says Pierre-Etienne Vannier, MSc, CHt, a leading expert in mind-body practices who specializes in patients who have experienced trauma, many of whom are veterans. While health care systems have been slow to adopt mind-body therapies, Vannier has seen a huge uptick in patients’ requests for these techniques.

“Patients are asking for it,” he says. “I have so many patients who say, ‘I need help to manage my pain, but I don’t want to be on opioids.’ There’s a need. There’s an awareness. There’s also an awaking of sorts when it comes to people and their own health. We are coming back to more self-managed treatments. We are coming back to more holistic treatments.”

And the trend is growing. In fact, more than 80% of specialized VA programs used to treat PTSD in veterans now offer some form of mind-body therapy. And with good reason — it works, says Vannier.

The Benefits of Mind-Body Therapies

In a recent review of nearly two dozen randomized VA trials on mind-body therapies, researchers gave three of the therapies a thumbs up: mindfulness, defined as a focused attention on present experiences without judgment; yoga, an integrative practice consisting of physical postures, breathing and meditation; and relaxation, a therapy that includes a variety of techniques like biofeedback training, imagery and visualization and progressive muscle relaxation. Although many of the studies were limited by the methodologies, according to the review — published in the Journal of Clinical Psychology — all three therapies showed significant reductions in PTSD symptoms. The review also examined the effects tai chi has on PTSD, and while no high-quality studies were found, researchers agree tai chi has great potential for reducing symptoms. Tai chi is an ancient form a martial art that incorporates slow movement, mindfulness, breathing and relaxation.

Lead researcher of the VA review, Barbara Niles, PhD, a research psychologist in the National Center for PTSD at the VA Boston Healthcare System who focuses on the use of mind-body therapies for trauma, led a small feasibility study on tai chi as a therapy for veterans who had major PTSD symptoms. She found that more than 90% of participants were satisfied with the program and many reported it helped manage their symptoms, including intrusive thoughts and difficulties concentrating, as well as improving attention, alertness and information processing.

All these mind-body therapies have also been shown to improve the mental and physical symptoms in patients with arthritis. For example, tai chi decreases pain and improves balance and coordination. Others, like mindfulness and cognitive behavioral therapy (CBT, a psychotherapeutic treatment that helps people learn how to identify and change destructive or disturbing thought patterns that have a negative influence on behavior and emotions) have been shown to be effective against depression, anxiety, alcohol and drug abuse and mental illness — all of which have been associated with arthritis and PTSD.

The VA currently endorses eight mind-body therapies: acupuncture , meditation , yoga, biofeedback (learning to control bodily functions by monitoring your own vital signs), clinical hypnosis , guided imagery , massage , and tai chi and qi gong (an ancient form of self-defense).

However, the most powerful therapies are often the simplest, like breathing, movement and self-touch, says Vannier.

What’s the Best Mind-Body Technique for Trauma?

The truth, says Vannier, “There is no best technique — that’s the frustrating part. It really depends on how your body resonates and where you are in that journey of healing. For me, as a practitioner 12 years into it, I’m working more systematically and less committedly because I’m seeing the truth of the body and the sensations. When we get lost in the story, then we get lost in details and we don’t have access to the real story of the body.

“We say, story follows state — the story in your mind follows the state of your nervous system. If my nervous system is activated, dysregulated, out-of-balance, then the story that comes with it, will be the same,” explains Vannier. “There’s nothing I can do. The more I do, the worse it gets. Going to the core issue, which is, how can we teach people how to self-regulate. How can we give them the skills to self-regulate? How can we give them agency in how they want to heal?”

From there, says Vannier, they can choose from hundreds of different mind-body techniques and find what works for their current state, whether it’s deep breathing, movement, group therapy, etc.

“We get lost in the technique, but it’s not about the technique,” says Vannier. “It’s about how can I integrate that technique.” For example, some patients may benefit from 10 minutes of meditation. For other patients, that same 10 minutes of meditation may only further activate their nervous system, causing too much trauma to rise to the surface and creating a state in which they cannot benefit from the treatment. When in fact, the patient may only require two minutes of meditation to activate their nervous system to connect with a manageable amount of trauma that feels safe to experience — as opposed to overwhelming.

“Then they may have a chance to say, ‘OK, this is my edge. I’m staying with it.’ It’s like bench pressing,” says Vannier. “I’m not going to try to bench press a ridiculous amount of weight. I can’t lift it. It’s the same thing for my nervous system. There are so many techniques out there that are closer to an exorcism than nervous system regulation. They say, ‘Bring it up, bring it up, bring it up. Be strong and face your fears!’ But that’s stress activation. Stress activation is a protective mechanism in your body and with it you’re not feeling things because your body doesn’t feel safe enough to feel it, to connect to it.”

The first step, says Vannier, is to heal and prepare the nervous system.

Healing the Nervous System, First

Healing the nervous system is the key to healing trauma, says Vannier, and should come before mind-body techniques are incorporated into post-trauma therapy. Simply put, “healing the nervous system means helping our nervous system respond appropriately to the situations we’re in,” he explains. “Which means, if I’m in a situation that requires me to be stressed, to be in fight or flight, then great. My nervous system is working well.” However, for trauma patients a state of stress is often not a life-saving mechanism. It’s a reaction to remnants of their trauma, whether it happened last week, last year or last decade.

“Time doesn’t heal in my experience,” says Vannier. “Unless we proactively work to process our ‘stuff,’ it’s not going to go away on its own. Healing my nervous system is making sure I’m able to feel safe when I am safe — that I’m able to recognize when I don’t need to be in that state of stress, I can be calm and achieve a state of relaxation, of feeling safe and peaceful. This is when I’m able to regenerate, to rejuvenate, to digest, to love and so forth.”

Cultural pressures can also hinder healing. Simply ‘pushing through,’ ‘staying strong,’ ‘putting on a brave face’ or ‘staying positive’ is not the answer either. These mantras are often mistaken for resilience. “We talk a lot about soldiers being resilient, but resilience is not knowing how to push through. It’s knowing when it’s safe enough for you to bring your guard down. When it’s safe enough for you to be vulnerable. When it’s safe enough for you to really connect. Because if I keep that armor up all the time, it gets in the way of a lot. It can be exhausting,” says Vannier.

Healing the nervous system is also about creating space to feel. “We need to make space for what we need to feel, which includes sadness, anger, anxiety, fear. Often when we’re in treatment we’re not given the space to experience all these normal human experiences. Healing can come from vulnerability when I don’t have to pretend, when I can be afraid or let myself be angry or sad without judgment — provided it’s safe. The big question is, are we providing places and creating environments where soldiers or anyone can go and (deep breath) say what they have to say without feeling like they’re not strong enough.”

To help patients heal and prepare their nervous systems, practitioners work with patients using the three phases to regulate their nervous systems:

1. Phase 1: Stabilization and Resourcing – The first phase starts with realization and embodiment. In this phase patients recognize and begin to build resources.

   “Before we get into all the traumatic things you’ve been through, we have to make sure you have the bandwidth and ability to process them in a way that feels helpful as opposed to overwhelming and retraumatizing,” explains Vannier. “This phase is too often overlooked, and patients are left overwhelmed. If someone is drowning, the first thing you do is not to ask them to go deeper. You get them out of the water, let them catch their breath and then potentially go into shallow waters and then eventually back into deeper waters”.

2. Phase 2: Processing — Using any number or combination of mind-body techniques, patients process the trauma in manageable chunks in this phase in order to achieve a sense of peace and healing. It’s important not to bite off more than you can chew, cautions Vannier. The process will take work and time.

3. Phase 3: Integrate and Understand — In this phase patients begin to understand the story differently, which is often achieved through a new point of view. In this phase, patients also begin to explore post-traumatic growth, which is the springboard to healing, says Vannier. “It lets us know that the trauma, as horrible as it was, happened, so what can we do from there? Post-traumatic growth reminds us that even though there are real problems and difficulties — psychologically, emotionally and physically — we will emerge from a traumatic experience. It reminds us that paradoxically, there are positive outcomes. Whether it’s seeing themselves stronger than they thought, having more gratitude for life, more gratitude for loved ones, not taking things for granted or spiritual changes.”

Tenets to Applying Mind-Body Techniques

No matter what mind-body therapy you choose, following these guidelines in your journey to healing trauma can help increase your success.

Embodiment. “Regardless of what kind of technique or approach people decide to adopt, No. 1, it’s important for that technique or approach be embodied,” says Vannier. “The reconnection to the body is crucial.” Emotional and physical pain disconnects us from the body. “We become overwhelmed by too much of something for too long, be it abuse or neglect or whatever it was that created that imbalance. It disconnects us from our bodies. Reconnection to the body is key.”

Pace. “Pace is important,” says Vannier. “The pace of my healing must be a pace that feels manageable.” For example, if a trauma has brought pain that you’ve carried for years, expecting it to be resolved in a month is unrealistic. It will take time to process it. “Respect what you’ve be dragging and the weight you’ve been carrying,” he says. “Because we live in a society where we ‘must achieve,’ that often gets projected onto our own therapy and healing.” Check in with yourself along your journey to see how you feel after a technique. Do you feel better? Do you feel healed? Do you feel at peace? “And do I understand that when I come out of that state of disconnection, I’m actually going to feel things? If you feel angry for example, it’s a step in the right direction.”

Community and Relationships. A sense of community and relationships can provide the support for the burdens you carry. “Connection is medicine,” says Vannier. “Isolation is a killer.” The implications of the COVID pandemic and the pressing need for connection for better mental health is just one example. “Once people are in a space in which they’re able to be heard, it’s just amazing how powerful these spaces can become.” However, Vannier notes, more spaces are needed for men, particularly soldiers who have experienced trauma.

Consistency. Healing from trauma takes work and persistence. “People need to realize that the three- or six-week program may not do it. It’s about changing routine,” explains Vannier. “People often don’t want to hear that. It takes work. Can you take 15 minutes out of your busy day? Can you take the amount of time your body is asking you to take? It’s a big question we must ask. Ownership and sovereignty are important. We’re leaving too many people with too many blind spots, unaware or uninvolved in their own healing. But I think this is changing because people want to be more involved and to be able to say, ‘There is something I can do.’”

If you’re living with PTOA or PTSD, help is available. The Arthritis Foundation and the U.S. Department of Veteran Affairs are working together to provide information and resources to support you. Visit arthritis.org/NewVAlink to learn more.